Surgical Preparation in Pediatric Orthopedics

Position for ease of access. Use prone position for clubfoot surgery and for release of knee flexion deformity. Positioning at the end of the table when possible allows greater freedom to maneuver around the patient during various stages of the procedure. Positioning on the child’s side allows procedures to be done from the front and back of the child without the need for redraping. If an intraoperative image is planned, position the C arm and consider placing a x-ray cassette under the patient before draping.

Mark Sites for Skin Incisions

To minimize incisional length, consider marking the exact sites for surgical procedures using the imaging intensifier.

Skin Preparation

Shave if excessive hair is present. Perform a surgical preparation 1% iodine in alcohol is effective and efficient, but has no commercial promoters, so its use is seldom appreciated. We have used iodine successfully for 30 years. Apply one coat of the iodine solution and allow it to dry. This provides a sterile field and enhances the adhesion of the plastic film used for draping. For open wounds, a bacteriostatic soap solution is used. Shaving is usually not necessary in children. Shaving may cause superficial skin lacerations and irritation, causing discomfort during the postoperative period.

Draping

Draping should provide adequate exposure for the surgical incision, a sterile barrier, and, if needed, free movement of the limb. The margins, or the entire operative field, may be secured with an adhesive plastic film. Without clips, radiographs are less cluttered. Drape to provide wide exposure of the operative field. This allows the surgeon to extend the incision if more exposure is required.

For reconstructive procedures that require intraoperative alignment, drape one or both extremities free. This allows the surgeon to make certain the alignment is correct for lower limb alignment osteotomies, hip fusions, and similar procedures.